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Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
Markets where an Anthem-Cigna merger warrants antitrust scrutinyAnalysis of data from the 2016 update to the AMA “Competition in health insurance: A comprehensive study of U.S. markets” Health Policy GroupAmerican Medical Association
IntroductionThis analysis provides the commercial market share and concentration (HHI) effects of the proposed merger between Anthem (WellPoint) and Cigna. Data used in this analysis are from the 2016 update to the AMA’s “Competition in health insurance” study (i.e., 2014 HealthLeaders-InterStudy data). Using the 2010 Department of Justice (DOJ)/Federal Trade Commission (FTC) Horizontal Merger Guidelines, it presents the state and metropolitan statistical area (MSA) level markets where the merger would raise competitive concerns based on how the Guidelines classify markets. Under the DOJ/FTC merger guidelines:
• MSAs with HHI less than 1500 are unconcentrated; mergers are unlikely to raise competitive concerns.
• MSAs with HHI between 1500 and 2500 are moderately concentrated; mergers that increase the HHI by more than 100 points potentially raise significant competitive concerns and often warrant scrutiny.
• MSAs with an HHI of more than 2500 are highly concentrated; mergers that increase the HHI by 100 to 200 points potentially raise significant competitive concerns and often warrant scrutiny, and those that increase it by more than 200 points will be presumed likely to enhance market power.
The following set of tables report those markets’ pre- and post-merger HHIs and the change in HHIs that would result from the proposed merger. The results are presented for commercial, combined (HMO+PPO+POS+EXCH) product markets as well as for HMO, PPO, POS and exchanges separately. For each product market, they are reported at the state-level and then by MSA.
The results are presented in a series of eight tables: Tables 1 and 2 (combined (HMO+PPO+POS+EXCH) markets); Table 3 (HMO markets); Tables 4 and 5 (PPO markets); Tables 6 and 7 (POS markets); and Table 8 (exchanges). For all plan types, we classify markets according to whether the merger will be presumed likely to enhance market power (reported in the top panels of the tables) or whether it potentially raises significant competitive concerns and often warrants scrutiny (reported in the bottom panels).
Results for combined (HMO+PPO+POS+EXCH) product markets State-level results
The results reported in the top panel of Table 1 indicate that an Anthem-Cigna merger would be presumed likely to enhance market power in the commercial, combined (HMO+PPO+POS+EXCH) markets in 10 of the 14 states (NH, IN, CT, ME, GA, VA, CO, MO, NV and KY) in which Anthem is licensed to provide commercial coverage.
The results presented in the bottom panel of Table 1 indicate that an Anthem-Cigna merger potentially raises significant competitive concerns and often warrants scrutiny in the other four states where Anthem operates (OH, CA, NY and WI).
2
Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
Although Table 1 shows that the merger would cause important changes in the HHI (concentration), we note that in Kentucky and Wisconsin, Cigna’s pre-merger market shares were 4 percent and 3 percent respectively. The significant increases in the HHI would be the result of Anthem’s existing high shares in those states.
MSA-level results
The results reported in Table 2 (top panel) indicate that an Anthem-Cigna merger would be presumed likely to enhance market power in the commercial, combined (HMO+PPO+POS+EXCH) markets in MSAs located in 13 of the 14 states (CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH and VA) in which Anthem is licensed to provide commercial coverage.
Finally, the results of the analysis in Table 2 (bottom panel) indicate that an Anthem-Cigna merger potentially raises significant competitive concerns and often warrants scrutiny in MSAs located in CA, CT, KY, MO, NH, NV, NY, OH, VA and WI.
Results by product market
State-level results
Table 4 (top panel) shows the 12 states (NH, IN, CO, GA, CT, VA, ME, CA, NV, MO, KY and OH) in which the merger will be presumed likely to enhance market power in the PPO market. Table 6 shows the three states (CA, NH and VA) in which the merger will be presumed likely to enhance market power in the POS market.
Table 4 (bottom panel) shows that in two additional states (WI and NY), the merger potentially raises significant competitive concerns and often warrants scrutiny in the PPO market.
MSA-level results
Turning to the results by MSA, Table 3 shows that in one MSA (Chattanooga, TN-GA), the proposed Anthem-Cigna merger will be presumed likely to enhance market power in the HMO market.1 Table 5 (top panel) shows the MSAs, which are located across all 14 “Anthem states” (CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH, VA and WI), where the merger is presumed likely to enhance market power in the PPO market. Table 7 (top panel) shows that MSAs meeting those criteria in the POS market are located in five states (CA, GA, IN, NH and VA).
Table 5 (bottom panel) shows the MSAs (in MO, NH, NY and WI) where the merger potentially raises significant competitive concerns and often warrants scrutiny in the PPO market, Table 7 (bottom panel) shows MSAs classified in that way (in CA and CT) for the POS market and Table 8 shows the relevant MSA (Chattanooga, TN-GA) for the exchanges.
It is uncertain, however, whether each of the product markets would be considered separate antitrust markets (i.e., not clear they are substitutes for each other). We also note that although all MSA-level results show that the merger would cause important changes in the HHI (concentration), in some MSAs Cigna’s pre-merger shares were small so that the change in the HHI was not very large. For example, that would generally be the case in combined (HMO+PPO+POS+EXCH) and PPO markets in California and Kentucky MSAs. The significant increase in the HHI would be the result of Anthem’s existing high shares in those MSAs.
1. We found no significant competitive effects at the state level for HMO markets and exchanges.
©2016 American Medical Association. All rights reserved. 16-0585:PDF:9/16:JT
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Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
Combined (HMO+PPO+POS+EXCH) marketsTable 1
StateCombined marketPre-merger HHI Post-merger HHI Change in HHI
States where an Anthem-Cigna merger will be presumed likely to enhance market power
New Hampshire 3024 4803 1779
Indiana 3615 5055 1440
Connecticut 2493 3788 1295
Maine 2728 3825 1097
Georgia 2329 3249 920
Virginia 2610 3484 874
Colorado 1845 2664 819
Missouri 2089 2582 492
Nevada 2317 2764 448
Kentucky 3010 3349 339
States where an Anthem-Cigna merger potentially raises significant competitive concerns and often warrants scrutiny
Ohio 2003 2321 318
California 2077 2358 281
New York 1734 1929 195
Wisconsin 1419 1526 107
Table 2
MSACombined marketPre-merger HHI Post-merger HHI Change in HHI
MSAs where an Anthem-Cigna merger will be presumed likely to enhance market power
California
Santa Cruz-Watsonville, CA 2867 3392 526
Salinas, CA 4309 4726 417
Santa Barbara-Santa Maria, CA 2892 3269 376
Visalia-Porterville, CA 3800 4172 372
Oxnard-Thousand Oaks-Ventura, CA 2397 2748 351
Bakersfield, CA 2687 2957 271
El Centro, CA 2914 3172 259
Merced, CA 3285 3540 255
Hanford-Corcoran, CA 3641 3893 252
Modesto, CA 2536 2739 202
Colorado
Grand Junction, CO 2134 3623 1488
Fort Collins-Loveland, CO 2324 3502 1178
Greeley, CO 2013 3189 1176
Pueblo, CO 2204 3218 1014
Colorado Springs, CO 1784 2692 908
Boulder, CO 1955 2775 820
Denver-Aurora, CO 1894 2500 606
4
Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
MSACombined marketPre-merger HHI Post-merger HHI Change in HHI
Connecticut
Hartford-West Hartford-East Hartford, CT 2515 3899 1383
Waterbury, CT 2718 4046 1327
New Haven-Milford, CT 2745 4056 1310
Bridgeport-Stamford-Norwalk, CT 2333 3527 1194
Danbury, CT 2291 3477 1186
Norwich-New London-Westerly, CT-RI 3109 3858 749
Georgia
Dalton, GA 4208 8367 4159
Rome, GA 2523 4177 1654
Savannah, GA 2575 3862 1288
Valdosta, GA 4905 6036 1131
Albany, GA 4965 6069 1104
Columbus, GA-AL 3545 4546 1001
Brunswick, GA 2934 3786 852
Hinesville-Fort Stewart, GA 4751 5556 805
Gainesville, GA 2375 3160 785
Athens-Clarke County, GA 3179 3920 741
Atlanta-Sandy Springs-Marietta, GA 2021 2742 721
Augusta-Richmond County, GA-SC 2267 2949 682
Warner Robins, GA 5046 5696 650
Chattanooga, TN-GA 2691 3313 622
Macon, GA 3080 3592 512
Indiana
Indianapolis, IN 3456 5618 2162
Terre Haute, IN 5782 7327 1545
Gary, IN 3158 4489 1331
Evansville, IN-KY 3595 4844 1249
Anderson, IN 5009 6219 1210
Kokomo, IN 4240 5441 1201
Michigan City-La Porte, IN 4268 5424 1156
Fort Wayne, IN 3708 4786 1077
Lafayette, IN 3147 4060 913
Elkhart-Goshen, IN 4515 5214 699
Muncie, IN 4073 4640 567
South Bend-Mishawaka, IN-MI 2871 3310 439
Bloomington, IN 4067 4460 394
Kentucky
Bowling Green, KY 3817 4677 860
Owensboro, KY 4667 5373 706
Clarksville, TN-KY 2069 2529 460
Louisville, KY-IN 2868 3239 371
Elizabethtown, KY 3534 3815 281
Lexington-Fayette, KY 3043 3253 210
Table 2 (continued)
5
Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
MSACombined marketPre-merger HHI Post-merger HHI Change in HHI
Maine
Bangor, ME 2607 4066 1460
Lewiston-Auburn, ME 3015 4315 1301
Portland-South Portland, ME 2802 3736 934
Missouri
St. Louis, MO-IL 2480 3031 551
Joplin, MO 2209 2689 480
Jefferson City, MO 2947 3222 276
Springfield, MO 2332 2581 249
Kansas City, MO-KS 2277 2501 224
Columbus, MO 3350 3550 200
New Hampshire
Rochester-Dover, NH 3210 4835 1625
Manchester, NH 2862 4449 1587
Nashua, NH-MA 2534 3839 1306
Portsmouth, NH-ME 2906 4160 1254
Nevada
Carson City, NV 2416 2915 499
Las Vegas-Paradise, NV 2929 3265 336
New York
Suffolk County-Nassau County, NY 2947 3200 253
Ohio
Parkersburg-Marietta-Vienna, WV-OH 1797 2680 884
Weirton-Steubenville, WV-OH 2568 3087 519
Cincinnati-Middletown, OH-KY-IN 2568 2960 392
Columbus, OH 2315 2688 373
Sandusky, OH 3070 3415 344
Lima, OH 2706 3036 330
Dayton, OH 2680 3009 329
Mansfield, OH 3596 3813 217
Virginia
Richmond, VA 3720 5353 1633
Winchester, VA-WV 3851 5016 1166
Lynchburg, VA 4443 5453 1011
Blacksburg-Christiansburg-Radford, VA 4527 5207 680
Kingsport-Bristol, TN-VA 2361 3041 680
Roanoke, VA 4318 4945 627
Virginia Beach-Norfolk-Newport News, VA-NC 3503 4062 559
Danville, VA 7280 7839 559
Harrisonburg, VA 5520 5983 463
Charlottesville, VA 3328 3643 315
MSAs where an Anthem-Cigna merger potentially raises significant competitive concerns and often warrants scrutiny
California
Santa Ana-Anaheim-Irvine, CA 1929 2427 497
San Jose-Sunnyvale-Santa Clara, CA 2109 2471 362
Los Angeles-Long Beach-Glendale, CA 2152 2472 320
Table 2 (continued)
6
Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
MSACombined marketPre-merger HHI Post-merger HHI Change in HHI
San Diego-Carlsbad-San Marcos, CA 1572 1824 252
San Francisco-San Mateo-Redwood City, CA 2016 2260 244
Riverside-San Bernardino-Ontario, CA 2148 2347 199
Oakland-Fremont-Hayward, CA 2798 2956 159
Stockton, CA 2892 3037 145
Sacramento-Arden-Arcade-Roseville, CA 2449 2552 103
Connecticut
Springfield, MA-CT 1901 2051 150
Kentucky
Huntington-Ashland, WV-KY-OH 2046 2331 285
Missouri
Fayetteville-Springdale-Rogers, AR-MO 1959 2224 265
St. Joseph, MO-KS 2934 3073 139
New Hampshire
Haverhill-Newburyport-Amesbury Town, MA-NH 1786 2161 375
Lawrence-Methuen-Salem, MA-NH 2045 2237 192
Nevada
Reno-Sparks, NV 1830 2348 518
New York
New York-White Plains-Wayne, NY-NJ 1993 2283 290
Poughkeepsie-Newburgh-Middletown, NY 1730 1971 241
Glens Falls, NY 1772 1893 121
Kingston, NY 1630 1750 120
Ohio
Wheeling, WV-OH 1968 2286 317
Youngstown-Warren-Boardman, OH-PA 1937 2200 263
Canton-Massillon, OH 1703 1936 234
Akron, OH 2084 2314 230
Springfield, OH 1978 2175 197
Cleveland-Elyria-Mentor, OH 2690 2884 194
Toledo, OH 2090 2264 174
Virginia
Washington-Arlington-Alexandria, DC-VA-MD-WV 1743 2085 342
Wisconsin
Racine, WI 3549 3722 172
Milwaukee-Waukesha-West Allis, WI 3235 3377 142
Table 2 (continued)
7
Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
HMO marketsTable 3
StatePre-merger HMO HHI
Post-merger HMO HHI Change in HHI
MSA where an Anthem-Cigna merger will be presumed likely to enhance market power
Georgia
Chattanooga, TN-GA 4597 4939 342
PPO marketsTable 4
StatePre-merger PPO HHI
Post-merger PPO HHI Change in HHI
States where an Anthem-Cigna merger will be presumed likely to enhance market power
New Hampshire 2956 5585 2629
Indiana 4343 6889 2546
Colorado 2831 5295 2464
Georgia 2940 5092 2151
Connecticut 2996 4985 1989
Virginia 3657 5336 1679
Maine 2637 3978 1341
California 3109 4202 1093
Nevada 1856 2897 1041
Missouri 2179 3012 833
Kentucky 3526 4073 547
Ohio 2652 3182 530
States where an Anthem-Cigna merger potentially raises significant competitive concerns and often warrants scrutiny
Wisconsin 1498 2067 569
New York 1645 1979 335
Table 5
MSAPre-merger PPO HHI
Post-merger PPO HHI Change in HHI
MSAs where an Anthem-Cigna merger will be presumed likely to enhance market power
California
San Jose-Sunnyvale-Santa Clara, CA 2516 4012 1496
Santa Cruz-Watsonville, CA 3835 5101 1266
San Diego-Carlsbad-San Marcos, CA 2590 3847 1257
Los Angeles-Long Beach-Glendale, CA 3523 4760 1236
Santa Ana-Anaheim-Irvine, CA 3167 4351 1184
Oakland-Fremont-Hayward, CA 2565 3700 1135
Riverside-San Bernardino-Ontario, CA 3174 4279 1105
8
Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
MSAPre-merger PPO HHI
Post-merger PPO HHI Change in HHI
San Francisco-San Mateo-Redwood City, CA 2505 3605 1099
Vallejo-Fairfield, CA 2711 3739 1029
Sacramento-Arden-Arcade-Roseville, CA 2732 3666 935
Stockton, CA 3450 4356 907
Bakersfield, CA 4251 5151 900
Oxnard-Thousand Oaks-Ventura, CA 3482 4351 870
Napa, CA 4966 5804 839
Modesto, CA 3312 4029 717
Visalia-Porterville, CA 4245 4900 655
Santa Rosa-Petaluma, CA 3358 3965 607
Salinas, CA 4185 4780 595
Santa Barbara-Santa Maria, CA 3291 3875 584
San Luis Obispo-Paso Robles, CA 4967 5211 514
Yuba City-Marysville, CA 5923 6423 500
Madera, CA 4779 5275 496
Fresno, CA 4060 4554 494
Hanford-Corcoran, CA 4079 4561 482
El Centro, CA 3436 3905 468
Merced, CA 3850 4272 422
Redding, CA 4191 4538 347
Colorado
Pueblo, CO 3401 6308 2907
Greeley, CO 3366 6230 2864
Fort Collins-Loveland, CO 3237 6014 2776
Grand Junction, CO 3056 5801 2745
Boulder, CO 2731 5093 2362
Colorado Springs, CO 2719 5056 2337
Denver-Aurora, CO 2842 5009 2167
Connecticut
Hartford-West Hartford-East Hartford, CT 3173 5340 2167
Waterbury, CT 3137 5133 1996
New Haven-Milford, CT 3161 5148 1987
Danbury, CT 2818 4542 1724
Bridgeport-Stamford-Norwalk, CT 2818 4540 1722
Norwich-New London-Westerly, CT-RI 3426 4948 1522
Springfield, MA-CT 2697 3029 332
Worcester, MA-CT 2583 2868 285
Georgia
Dalton, GA 5369 8778 3409
Rome, GA 3175 5865 2690
Savannah, GA 2798 5080 2282
Valdosta, GA 4105 6354 2249
Brunswick, GA 3505 5733 2228
Athens-Clarke County, GA 4241 6461 2220
Albany, GA 3738 5713 1975
Atlanta-Sandy Springs-Marietta, GA 2873 4785 1912
Table 5 (continued)
9
Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
MSAPre-merger PPO HHI
Post-merger PPO HHI Change in HHI
Gainesville, GA 2720 4579 1859
Columbus, GA-AL 3205 4940 1734
Hinesville-Fort Stewart, GA 4594 6264 1670
Macon, GA 3616 5067 1451
Warner Robins, GA 4542 5808 1266
Augusta-Richmond County, GA-SC 2458 3381 923
Chattanooga, TN-GA 3662 4155 493
Indiana
Indianapolis, IN 4093 7543 3450
Gary, IN 3755 6226 2471
Terre Haute, IN 5802 8107 2306
Kokomo, IN 5762 8023 2260
Michigan City-La Porte, IN 5303 7466 2163
Anderson, IN 5978 8135 2158
Evansville, IN-KY 3863 5846 1983
Fort Wayne, IN 4596 6573 1977
Lafayette, IN 3337 4843 1506
Muncie, IN 6636 8049 1413
Elkhart-Goshen, IN 5787 7178 1390
Columbus, IN 6577 7520 943
South Bend-Mishawaka, IN-MI 3472 4263 791
Bloomington, IN 5161 5930 769
Kentucky
Bowling Green, KY 5399 7076 1677
Owensboro, KY 6198 7458 1260
Clarksville, TN-KY 2716 3376 660
Louisville, KY-IN 3418 4045 628
Elizabethtown, KY 3876 4284 407
Hungtington-Ashland, WV-KY-OH 2224 2601 376
Lexington-Fayette, KY 3318 3624 306
Maine
Bangor, ME 2786 4460 1674
Lewiston-Auburn, ME 2861 4303 1442
Portland-South Portland, ME 2601 3804 1202
Missouri
St. Louis, MO-IL 2614 3805 1191
Joplin, MO 2257 2964 707
Jefferson City, MO 3079 3665 586
Fayetteville-Springdale-Rogers, AR-MO 2256 2813 558
Springfield, MO 2602 2940 338
Kansas, City, MO-KS 2910 3218 308
Columbia, MO 4857 5098 241
New Hampshire
Rochester-Dover, NH 3028 5519 2492
Manchester, NH 2872 5345 2473
Nashua, NH-MA 2506 4552 2046
Table 5 (continued)
10
Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
MSAPre-merger PPO HHI
Post-merger PPO HHI Change in HHI
Portsmouth, NH-MA 2652 4507 1855
Haverhill-Newburyport-Amesbury Town, MA-NH 1938 2529 590
Lawrence-Methuen-Salem, MA-NH 2317 2636 319
Nevada
Reno-Sparks, NV 2207 3355 1148
Carson City, NV 3094 4049 955
Las Vegas-Paradise, NV 1847 2693 846
New York
New York-White Plains-Wayne, NY-NJ 1998 2594 596
Suffolk County-Nassau County, NY 2398 2836 438
Ohio
Parkersburg-Marietta-Vienna, WV-OH 1964 3044 1080
Cincinnati-Middletown, OH-KY-IN 3358 4313 955
Dayton, OH 3865 4808 943
Columbus, OH 2456 3209 753
Weirton-Steubenville, WV-OH 2675 3329 654
Springfield, OH 2505 3042 537
Wheeling, WV-OH 2132 2563 431
Canton-Massillon, OH 2636 3035 398
Sandusky, OH 3465 3855 389
Lima, OH 3255 3596 341
Youngstown-Warren-Boardman, OH-PA 2193 2513 321
Toledo, OH 2819 3127 308
Akron, OH 2609 2904 296
Cleveland-Elyria-Mentor, OH 3769 4022 253
Mansfield, OH 4665 4885 219
Virginia
Richmond, VA 4029 6377 2348
Lynchburg, VA 4623 6116 1484
Winchester, VA-WV 4040 5458 1418
Virginia Beach-Norfolk-Newport News, VA-NC 4726 6073 1347
Washington-Arlington-Alexandria, DC-VA-MD-WV 2181 3323 1141
Blacksburg-Christiansburg-Radford, VA 4695 5656 962
Roanoke, VA 4616 5529 913
Danville, VA 7617 8442 825
Kingsport-Bristol, TN-VA 2991 3744 753
Harrisonburg, VA 7004 7662 658
Charlottesville, VA 3714 4205 490
Wisconsin
Racine, WI 1829 2561 732
Wausau, WI 2629 3300 671
Eau Claire, WI 2052 2659 606
Milwaukee-Waukesha-West Allis, WI 1971 2535 564
Sheboygan, WI 2273 2578 305
MSAs where an Anthem-Cigna merger potentially raises significant competitive concerns and often warrants scrutiny
Missouri
St. Joseph, MO-KS 3241 3398 157
Table 5 (continued)
11
Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
MSAPre-merger PPO HHI
Post-merger PPO HHI Change in HHI
New Hampshire
Lowell-Billerica-Chelmsford, MA-NH 2628 2807 179
Boston-Cambridge-Quincy, MA-NH 2825 2946 121
New York
Poughkeepsie-Newburgh-Middletown, NY 1594 1910 316
Kingston, NY 1547 1705 157
Glens Falls, NY 1822 1978 156
Wisconsin
Green Bay, WI 1521 2472 951
Fond du Lac, WI 1449 2103 655
Appleton, WI 1610 2188 578
Janesville, WI 1653 2207 554
Oshkosh-Neenah, WI 1920 2443 524
Madison, WI 1449 1895 446
La Crosse, WI-MN 1911 2028 117
POS marketsTable 6
StatePre-merger POS HHI
Post-merger POS HHI Change in HHI
States where an Anthem-Cigna merger will be presumed likely to enhance market power
California 3792 4247 455
New Hampshire 4799 5186 387
Virginia 2771 2982 211
Table 7
MSAPre-merger POS HHI
Post-merger POS HHI Change in HHI
MSAs where an Anthem-Cigna merger will be presumed likely to enhance market power
California
Santa Ana-Anaheim-Irvine, CA 3224 4335 1111
Los Angeles-Long Beach-Glendale, CA 3155 3794 639
Santa Barbara-Santa Maria, CA 4286 4860 574
Riverside-San Bernardino-Ontario, CA 2620 3088 468
San Diego-Carlsbad-San Marcos, CA 4682 5001 320
Oxnard-Thousand Oaks-Ventura, CA 4176 4494 319
San Francisco-San Mateo-Redwood City, CA 5404 5633 228
Georgia
Chattanooga, TN-GA 3881 4540 659
Indiana
Kokomo, IN 4838 5453 615
Table 5 (continued)
12
Markets where an Anthem-Cigna merger warrants antitrust scrutiny | Analysis of data from the 2016 update to the AMA “Competition in health insurance” study
MSAPre-merger POS HHI
Post-merger POS HHI Change in HHI
MSAs where an Anthem-Cigna merger will be presumed likely to enhance market power
New Hampshire
Rochester-Dover, NH 5287 5661 374
Manchester, NH 4751 5015 264
Virginia
Winchester, VA-WV 4267 5375 1107
Harrisonburg, VA 3323 3665 341
Richmond, VA 3868 4161 293
MSAs where an Anthem-Cigna merger potentially raises significant competitive concerns and often warrants scrutiny
California
Oakland-Fremont-Hayward, CA 5414 5612 198
Sacramento-Arden-Arcade-Roseville, CA 5159 5335 176
Vallejo-Fairfield, CA 5283 5429 146
Connecticut
Hartford-West Hartford-East Hartford, CT 3212 3398 186
ExchangesTable 8
StatePre-merger EXCH HHI
Post-merger EXCH HHI Change in HHI
MSA where an Anthem-Cigna merger potentially raises significant competitive concerns and often warrants scrutiny
Georgia
Chattanooga, TN-GA 5389 5583 194
Table 7 (continued)